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Do Tailored Chemotherapy Regimens Improve Outcomes in Early-Stage NSCLC?

By: Julia Fiederlein
Posted: Monday, March 8, 2021

Tailoring adjuvant chemotherapy based on the mRNA expression of selected genes does not seem to confer a statistically significant overall or relapse-free survival advantage in patients with completely resected stage II to III non–small cell lung cancer (NSCLC), according to Silvia Novello, MD, PhD, of the University of Turin, Italy, and colleagues. The multicenter phase III ITACA trial results were presented in January 2021 during the virtual edition of the International Association for the Study of Lung Cancer 2020 World Conference on Lung Cancer Singapore (WCLC; Abstract PS01.04).

“mRNA expression of some genes was correlated with the sensitivity or resistance to specific anticancer agents,” the investigators noted. “We aimed to evaluate the predictive utility of the mRNA expression levels of molecular markers ERCC1 and TS.”

In the experimental group (n = 384), patients were assigned to a regimen based on the results of genomic analyses: patients whose tumors had high ERCC1 and TS levels received docetaxel; those with high ERCC1 and low TS levels received pemetrexed; patients with tumors that had low ERCC1 and high TS levels received cisplatin plus gemcitabine, and those with tumors that had low ERCC1 and TS levels received cisplatin plus pemetrexed. Patients assigned to the control group (n = 389) were administered cisplatin plus gemcitabine, cisplatin plus vinorelbine, cisplatin plus docetaxel, platinum plus pemetrexed, or another regimen.

At a median follow-up of 28.2 months, the death rate was higher in the control group than in the experimental group (24.9% vs. 19.8%). The estimated median durations of overall survival were 83.5 and 96.4 months in the control and experimental groups, respectively (P = .091). Grade 3 to 5 neutropenia (18.9% vs. 13.4%), leukopenia (13.3% vs. 3.9%), thrombocytopenia (7.7% vs. 3.3%), and anemia (2.7% vs. 0.9%) were reported more frequently in the control group than in the experimental group.

Disclosure: For full disclosures of the study authors, visit wclc2020.iaslc.org.



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